It’s funny how terms catch on. Sometimes it’s the result of an innovator’s brand. No one goes out to play flying disc — we play Frisbee. Sometimes it’s the result of simplification. Everyone in healthcare knows about PACS — even when many (if not most) don’t know what exactly PACS (picture archiving and communication system) means. Then there is that instance when a term is generally used but doesn’t necessarily fit — either by innovation or by general adoption.
The term vendor neutral archive (VNA) gained traction in the medical imaging space in the late 2000s, initially coined as “PACS neutral archive” by Michael Gray, principal of Gray Consulting. It was the early breach into discussing a way of providing archive solutions across multiple, or more simply other, vendor’s image data. To that point, all functions of image management post-acquisition were assumed to be the function of the single vendor that managed workflow, visualization, distribution and storage — the system we termed PACS. The term quickly morphed from “PACS neutral” to “vendor neutral” and subsequently became the market’s standard for a storage solution that was separate or decoupled from the PACS vendor.
At that same time many customers were facing PACS system replacements for various reasons. The replacement effort was nearly always technically challenging, taxing on resources and lengthy due to migration efforts. For many, the frustration was directed at the vendors, and as a result the idea of taking data management and migration away became compelling — even if many were not ready to adopt this new technology. A separate or decoupled archive solution was sought that kept data in a more open and liquid state, served to reduce costs and migration challenges and which correspondingly grew in importance for many large-size provider networks and integrated delivery networks (IDN).
This demand moved nearly all PACS vendors toward providing a “vendor”-branded VNA solution. This movement, I believe, served to immediately create confusion around what the term really meant, and subsequently, what the technology was designed to do. By the time the term had matured, any attempt to rename the technology would have only introduced more chaos into the market conversation.
As the technology has advanced, many of the early benefits of the VNA have been superseded by other functions introduced by VNA vendors. Archiving and data migration tools have become the more rudimentary of functions for what we now call VNA. Archiving has adopted image lifecycle management (ILM) rules for better storage management. Other functions such as data normalization, contextualized content and workflow functions are increasingly critical to decision-makers looking to select a solution. An elegant VNA solution should now act more like an imaging platform than simply an archive.
The Move to Multi-vendor Ecosystems
The initial decoupling of the archive followed now by many other functions, away from what was traditionally managed by the single-vendor PACS, brought the advent of multi-vendor environments. In many current implementations there are several vendors working together to provide the enterprise and departmental solutions. This stratification of technology in imaging has been adopted initially by leading-edge IT groups that have either the capital or internal expertise to foray into this model. The terminology for this approach has also taken on differing terms, including PACS 2.0 and Imaging 3.0, and while each have nuanced differences, many mean the same thing.
This multi-vendor approach brings its own set of costs and benefits. Some of the new complexities of this environment require superior IT expertise in-house. The support model of a single vendor who likely had a field engineer nearby doesn’t fit in the multi-vendor model. The vendor support is largely remote, and the tools for support and administration are owned by the IT resources assigned internally. As such, these resources must stay current on the technology with an eye toward the larger system architecture. In addition, the management of vendors in this model requires a stringent set of terms and conditions related to issue management and resolution such as an integrated service level agreement (ISLA).
As a result, there remains the single vendor option. Most of the PACS vendors are now moving toward an enterprise suite of modules or options to address the complexity of enterprise imaging. But providers face many of the same challenges and frustrations experienced in the PACS era. Still, customers have determined that the best solution remains a single-vendor ecosystem for enterprise imaging.
This has only served to further confuse the market as many continue to ask some very important questions: What does vendor neutral mean? What is considered a vendor? Is any solution ever really vendor neutral?
Market Consolidation
The market has now begun to mature and in a completely normal trend, we are beginning to see consolidation with the VNA vendors. Enterprise resource planning (ERP) systems have consolidated in manufacturing and retail. Telecom has consolidated. While this is what we all have expected would happen, it brings about a question for anyone who is looking to adopt this technology: What is the role of the vendor in your preferred solution model? Many of the smaller vendors — including VNAs, univiewers and workflow engines — have touted their ability be nimble and responsive, and have demonstrated that ability to their customers with quick code changes, customizations and patches. They also emphasize their adherence to standards in integration, interfaces and transfer protocols. As a result, the ecosystem is nimble and flexible: Modules (vendors) can be replaced for any number of reasons, most of which are similar to reasons customers looked to replace their first PACS. The value of this multi-vendor model then can be realized with less disruption, quicker implementations and significant reduction in capital expenditure.
Related Enterprise Imaging Content
Access the most current version of the ITN VNA Comparison Chart (www.itnonline.com/content/vendor-neutral-archives). This will require a login, but it is free and only takes a minute to complete the form.
RSNA Technology Report 2015: Enterprise Imaging
VIDEO: Creating an Enterprise Imaging System
Strategy is Key to Enterprise Imaging Success
Deconstructing PACS in Developing Enterprise Imaging
An Ounce of VNA Strategy is Worth a Pound of Remediation
Users Will Determine Whether Enterprise Imaging Succeeds
Deconstructing PACS: Point/Counterpoint
Enterprise Imaging Will Help Industry Achieve Patient-centric Care
Understanding Enterprise Imaging
Jef Williams is the chief operating officer at Ascendian Healthcare Consulting.
April 11, 2024 
